<?php /* Smarty version 2.6.26, created on 2013-03-23 06:10:53
         compiled from ../templates/pc%5Cjoin_member_check.html */ ?>
<?php require_once(SMARTY_CORE_DIR . 'core.load_plugins.php');
smarty_core_load_plugins(array('plugins' => array(array('modifier', 'U', '../templates/pc\\join_member_check.html', 72, false),array('modifier', 'cat', '../templates/pc\\join_member_check.html', 112, false),)), $this); ?>
<!DOCTYPE html>
<html lang="ja">
<head>
	<meta charset="UTF-8">
	<title>確認画面 | メンバー登録 | デンタルダイヤモンド社</title>
	<meta http-equiv="X-UA-Compatible" content="IE=EmulateIE7" />
	<meta name="description" content="デンタルダイヤモンド社 :: 月刊デンタルダイヤモンド、DH Styleをはじめ、様々な書籍の情報閲覧が可能です。またその場で購入ができるオンラインショッピングも充実しております。">
	<meta name="keywords" content="補綴,咬合,有床義歯,クラウンブリッジ,インプラント,保存修復,歯内療法,歯周治療,歯科矯正,口腔外科,口腔診断,歯科X線,全身管理,予防歯科,高齢者歯科,若手歯科医のための臨床の技,月刊,チェアーサイドのガイドブック,ポケットブック,医事,経営,社会保険,スタッフ教育,待合室・患者指導用絵本,診療説明用リーフレット,デンタル,ダイヤモンド,デンタルダイヤモンド,歯学書,歯科">
	
	<!-- stylesheets -->
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	<!-- javascript -->
	<script src="pc/assets/js/html5shiv-printshiv.js" type="text/javascript"></script>
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</head>

<body>
	<div id="wrapper">

		<noscript>このサイトはJavaScriptがオンになっていないと正常に表示されません</noscript>

		<header>
			<div id="header_inner">
				<nav>
					<ul>
						<li><a href="" title="ログインする">ログインする</a></li>
						<li><a href="" title="買い物カゴ">買い物カゴ</a></li>
						<li><a href="" title="マイページ">マイページ</a></li>
					</ul>
				</nav>
				
				<h1><a href="/" title="デンタルダイヤモンド社">デンタルダイヤモンド社</a></h1>
				<div id="searchbox">
					<form id="form_quickSearch" action="" method="get" name="focus">
						<input type="text" name="keyword" id="text_keyword" class="text_keyword" style="color:#999;" onFocus="cText(this)" onBlur="sText(this)" value="キーワード検索">
						<input type="hidden" name="sType" value="1" />
						<button type="submit" title="商品を検索">商品を検索</button>
					</form>
				</div>
			</div>
		</header>
		
		<ol id="pan">
			<li><a href="">ホーム</a></li>
			<li><a href="">メンバー登録</a></li>
			<li>確認画面</li>
		</ol>

		<section id="main">
			<div id="main_inner">
				<div id="top_detail">
					<div id="join_member">
						<h1>メンバー登録確認</h1>
						
						<p class="atention">
							アカウント作成に必要な情報をご入力ください。<br>
							<em>●の項目は必須事項となります。</em>
						</p>
						
						<h2>メンバー情報の登録</h2>
						<form name="entryForm" action="<?php echo ((is_array($_tmp='pc/topJoin/insert')) ? $this->_run_mod_handler('U', true, $_tmp) : U($_tmp)); ?>
" method="post" target="_top">
							<input type="hidden" name="mode" value="submit">
							<div class="form_detail">
								<table>
									<tbody>
										<tr>
											<th class="require"><em>●</em>メールアドレス</th>
											<td class="must">必須</td>
											<td><?php echo $this->_tpl_vars['forms']['email1']; ?>
</td>
											<input type="hidden" name="email" value="<?php echo $this->_tpl_vars['forms']['email1']; ?>
">
										</tr>
										<tr>
											<th class="require"><em>●</em>お客様ID</th>
											<td class="must">必須</td>
											<td><?php echo $this->_tpl_vars['forms']['login_id']; ?>
</td>
											<input type="hidden" name="login_id" value="<?php echo $this->_tpl_vars['forms']['login_id']; ?>
">
										</tr>
										<tr>
											<th class="require"><em>●</em>パスワード</th>
											<td class="must">必須</td>
											<td><?php echo $this->_tpl_vars['forms']['login_pwd']; ?>
</td>
											<input type="hidden" name="login_pwd" value="<?php echo $this->_tpl_vars['forms']['login_pwd']; ?>
">
										</tr>
										<tr>
											<th class="require"><em>●</em>氏名(漢字) </th>
											<td class="must">必須</td>
											<td><?php echo $this->_tpl_vars['forms']['user_name1']; ?>
&nbsp;&nbsp;&nbsp;<?php echo $this->_tpl_vars['forms']['user_name2']; ?>
</td>
											<input type="hidden" name="user_name1" value="<?php echo $this->_tpl_vars['forms']['user_name1']; ?>
">
											<input type="hidden" name="user_name2" value="<?php echo $this->_tpl_vars['forms']['user_name2']; ?>
">										
										</tr>
										<tr>
											<th class="require"><em>●</em>氏名(フリガナ) </th>
											<td class="must">必須</td>
											<td><?php echo $this->_tpl_vars['forms']['user_name_furikana1']; ?>
&nbsp;&nbsp;&nbsp;<?php echo $this->_tpl_vars['forms']['user_name_furikana2']; ?>
</td>
											<input type="hidden" name="user_name_furikana1" value="<?php echo $this->_tpl_vars['forms']['user_name_furikana1']; ?>
">
											<input type="hidden" name="user_name_furikana2" value="<?php echo $this->_tpl_vars['forms']['user_name_furikana2']; ?>
">
										</tr>
										<tr>
											<th class="require"><em>●</em>郵便番号</th>
											<td class="must">必須</td>
											<td><?php echo ((is_array($_tmp=$this->_tpl_vars['forms']['zipcode1'])) ? $this->_run_mod_handler('cat', true, $_tmp, "-") : smarty_modifier_cat($_tmp, "-")); ?>
<?php echo $this->_tpl_vars['forms']['zipcode2']; ?>
</td>
											<input type="hidden" name="zipcode" value="<?php echo ((is_array($_tmp=$this->_tpl_vars['forms']['zipcode1'])) ? $this->_run_mod_handler('cat', true, $_tmp, '-') : smarty_modifier_cat($_tmp, '-')); ?>
<?php echo $this->_tpl_vars['forms']['zipcode2']; ?>
">
										</tr>
										<tr>
											<th class="require"><em>●</em>都道府県</th>
											<td class="must">必須</td>
											<td><?php echo $this->_tpl_vars['local_name']; ?>
</td>
											<input type="hidden" name="local_cd" value="<?php echo $this->_tpl_vars['forms']['local_cd']; ?>
">
										</tr>
										<tr>
											<th class="require"><em>●</em>市区郡</th>
											<td class="must">必須</td>
											<td><?php echo $this->_tpl_vars['forms']['treet_name']; ?>
</td>
											<input type="hidden" name="treet_name" value="<?php echo $this->_tpl_vars['forms']['treet_name']; ?>
<?php echo $this->_tpl_vars['forms']['treet_name2']; ?>
">
										</tr>
										<tr>
											<th class="require"><em>●</em>町村</th>
											<td class="must">必須</td>
											<td><?php echo $this->_tpl_vars['forms']['treet_name2']; ?>
</td>
											
										</tr>
										<tr>
											<th class="require"><em>●</em>それ以降の住所</th>
											<td class="must">必須</td>
											<td><?php echo $this->_tpl_vars['forms']['address']; ?>
</td>
											<input type="hidden" name="address" value="<?php echo $this->_tpl_vars['forms']['address']; ?>
">
										</tr>
										<tr>
											<th class="require"><em>●</em>電話番号</th>
											<td class="must">必須</td>
											<td><?php echo $this->_tpl_vars['forms']['tel_number1']; ?>
 - <?php echo $this->_tpl_vars['forms']['tel_number2']; ?>
 - <?php echo $this->_tpl_vars['forms']['tel_number3']; ?>
</td>
											<input type="hidden" name="tel_number" value="<?php echo ((is_array($_tmp=$this->_tpl_vars['forms']['tel_number1'])) ? $this->_run_mod_handler('cat', true, $_tmp, '-') : smarty_modifier_cat($_tmp, '-')); ?>
<?php echo ((is_array($_tmp=$this->_tpl_vars['forms']['tel_number2'])) ? $this->_run_mod_handler('cat', true, $_tmp, '-') : smarty_modifier_cat($_tmp, '-')); ?>
<?php echo $this->_tpl_vars['forms']['tel_number3']; ?>
">
										</tr>
										<tr>
											<th>FAX番号</th>
											<td>&nbsp;</td>
											<td><?php echo ((is_array($_tmp=$this->_tpl_vars['forms']['mobile_number1'])) ? $this->_run_mod_handler('cat', true, $_tmp, '-') : smarty_modifier_cat($_tmp, '-')); ?>
<?php echo ((is_array($_tmp=$this->_tpl_vars['forms']['mobile_number2'])) ? $this->_run_mod_handler('cat', true, $_tmp, '-') : smarty_modifier_cat($_tmp, '-')); ?>
<?php echo $this->_tpl_vars['forms']['mobile_number3']; ?>
</td>
											<input type="hidden" name="mobile_number" value="<?php echo ((is_array($_tmp=$this->_tpl_vars['forms']['mobile_number1'])) ? $this->_run_mod_handler('cat', true, $_tmp, '-') : smarty_modifier_cat($_tmp, '-')); ?>
<?php echo ((is_array($_tmp=$this->_tpl_vars['forms']['mobile_number2'])) ? $this->_run_mod_handler('cat', true, $_tmp, '-') : smarty_modifier_cat($_tmp, '-')); ?>
<?php echo $this->_tpl_vars['forms']['mobile_number3']; ?>
">
										</tr>
										<tr>
											<th>
												貴医院名・<br>
												貴技工所名(漢字)
											</th>
											<td>&nbsp;</td>
											<td><?php echo $this->_tpl_vars['forms']['workshop_name']; ?>
&nbsp;</td>
										</tr>
										<tr>
											<th>
												貴医院名・<br>
												貴技工所名(フリガナ)
											</th>
											<td>&nbsp;</td>
											<td><?php echo $this->_tpl_vars['forms']['workshop_name_furikana']; ?>
&nbsp;</td>
										</tr>
										<tr>
											<th class="require"><em>●</em>生年月</th>
											<td class="must">必須</td>
											<td><?php echo $this->_tpl_vars['forms']['birth1']; ?>
 年 <?php echo $this->_tpl_vars['forms']['birth2']; ?>
 月</td>
										</tr>
										<tr>
											<th class="require"><em>●</em>性別</th>
											<td class="must">必須</td>
											<td><?php echo $this->_tpl_vars['sex']; ?>
</td>
										</tr>
										<tr>
											<th>メールマガジン（PC版）</th>
											<td>&nbsp;</td>
											<td class="b10"><?php echo $this->_tpl_vars['send']; ?>
</td>
										</tr>
									</tbody>
								</table>
							</div>
										
										
							<h2>別配送先の登録確認</h2>
							<div class="form_detail">
								<table>
									<tbody>
										<tr>
											<th>氏名（漢字）</th>
											<td>&nbsp;</td>
											<td><?php echo $this->_tpl_vars['forms']['sent_name1']; ?>
&nbsp;&nbsp;<?php echo $this->_tpl_vars['forms']['sent_name2']; ?>
&nbsp;</td>
										</tr>
										<tr>
											<th>氏名（フリガナ）</th>
											<td>&nbsp;</td>
											<td><?php echo $this->_tpl_vars['forms']['sent_name_furikana1']; ?>
&nbsp;&nbsp;<?php echo $this->_tpl_vars['forms']['sent_name_furikana2']; ?>
&nbsp;</td>
										</tr>
										<tr>
											<th>郵便番号</th>
											<td>&nbsp;</td>
											<td><?php echo $this->_tpl_vars['forms']['sent_zipcode1']; ?>
 - <?php echo $this->_tpl_vars['forms']['sent_zipcode2']; ?>
&nbsp;</td>
										</tr>
										<tr>
											<th>都道府県</th>
											<td>&nbsp;</td>
											<td><?php echo $this->_tpl_vars['sent_local_name']; ?>
&nbsp;</td>
										</tr>
										<tr>
											<th>市区郡</th>
											<td>&nbsp;</td>
											<td><?php echo $this->_tpl_vars['forms']['sent_treet_name']; ?>
&nbsp;</td>
										</tr>
										<tr>
											<th>それ以降の住所</th>
											<td>&nbsp;</td>
											<td><?php echo $this->_tpl_vars['forms']['sent_address']; ?>
&nbsp;</td>
										</tr>
										<tr>
											<th>電話番号</th>
											<td>&nbsp;</td>
											<td><?php echo $this->_tpl_vars['forms']['sent_tel_number1']; ?>
 - <?php echo $this->_tpl_vars['forms']['sent_tel_number1']; ?>
 - <?php echo $this->_tpl_vars['forms']['sent_tel_number1']; ?>
&nbsp;</td>
										</tr>
										<tr>
											<th>
												貴医院名・<br>
												貴技工所名（漢字）
											</th>
											<td>&nbsp;</td>
											<td><?php echo $this->_tpl_vars['forms']['sent_workshop_name1']; ?>
&nbsp;</td>
										</tr>
										<tr>
											<th>
												貴医院名・<br>
												貴技工所名（フリガナ）
											</th>
											<td>&nbsp;</td>
											<td><?php echo $this->_tpl_vars['forms']['sent_workshop_name2']; ?>
&nbsp;</td>
										</tr>
									</tbody>
								</table>
							</div>
										
							<dl id="registration">
								<dt><a href="#" onClick="history.go(-1);return false;" title="戻る">戻る</a></dt>
								<dd><input type="submit" title="登録する"></dd>								
							</dl>
							<br clear="all">
						</form>
					</div>
				</div>
			</div>
		</section>

		<section id="r_clm">
			<h4>Information</h4>
			<ul id="info">
				<li><a href="">ご利用案内</a></li>
				<li><a href="">求人案内</a></li>
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				<li><a href="">トピックス</a></li>
				<li><a href="">販売支援</a></li>
				<li><a href="">会社概要</a></li>
				<li><a href="">お問い合せ</a></li>
			</ul>
			
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			<ul class="line2nd">
				<li><a href="">ホーム</a></li>
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	</div>
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